Insulin Lispro Dosing Strategy

Basic Principles of Prandial Insulin Dosing

The American Diabetes Association recommends initial prandial insulin dosing typically starts at 4 units per dose, 0.1 units/kg, or 10% of the basal insulin dose 2, 3
When adding prandial insulin to a regimen, consider reducing the basal insulin dose by 4 units or 10% if A1C is <8% to prevent hypoglycemia in patients with diabetes 3, 4
Prandial insulin is usually initiated with one dose at the largest meal or the meal with the greatest postprandial glucose excursion in patients with diabetes 2, 5

For premeal glucose >250 mg/dL, the standard sliding scale protocol recommends adding 2 units of Humalog (insulin lispro) in patients with high blood glucose levels 1, 6
For premeal glucose >350 mg/dL, the standard sliding scale protocol recommends adding 4 units of Humalog (insulin lispro) in patients with very high blood glucose levels 1, 6
Titrate the dose by increasing 1-2 units or 10-15% twice weekly based on glucose response in patients with diabetes 2, 5

In older adults, a simplified sliding scale may be more appropriate with lower targets (90-150 mg/dL) to reduce hypoglycemia risk in elderly patients with diabetes 7, 8
For frail elderly patients, consider discontinuing sliding scale when not needed daily to reduce medication burden in elderly patients with diabetes 1, 6
Avoid using rapid-acting insulin at bedtime in older adults to prevent nocturnal hypoglycemia in elderly patients with diabetes 1

If initial prandial dosing is insufficient, consider stepwise addition of additional prandial insulin injections (progressing from one to three meals) in patients with uncontrolled diabetes 2, 5
When advancing to multiple daily injections, maintain metformin while considering discontinuation of other oral agents to avoid unnecessarily complex regimens in patients with diabetes 4

Assess blood glucose values every 2 weeks and adjust doses if 50% of premeal values are above target in patients with diabetes 1
Decrease dose if more than 2 premeal glucose values per week are below target range in patients with diabetes 1

During Ramadan or other fasting periods, consider adjusting the Humalog dose to match the timing and size of meals in patients with diabetes who fast 9